FILE - In this Thursday, July 1, 2021, file photo, Melinda Gates, co-chair of the Bill and Melinda Gates Foundation, poses for photographers as she arrives for a meeting after a meeting on the sideline of the gender equality conference at the Elysee Palace in Paris. Philanthropists Melinda French Gates, MacKenzie Scott and the family foundation of billionaire Lynn Schusterman awarded $40 million Thursday, July 29, 2021, to four gender equality projects. (AP Photo/Michel Euler, File) (AP)
FILE - In this Thursday, July 1, 2021, file photo, Melinda Gates, co-chair of the Bill and Melinda Gates Foundation, poses for photographers as she arrives for a meeting after a meeting on the sideline of the gender equality conference at the Elysee Palace in Paris. Philanthropists Melinda French Gates, MacKenzie Scott and the family foundation of billionaire Lynn Schusterman awarded $40 million Thursday, July 29, 2021, to four gender equality projects. (AP Photo/Michel Euler, File) (AP)

India’s vaccine drive remarkable: Melinda Gates

In an emailed interview to Rhythma Kaul, Gates Foundation co-chair Melinda French Gates explains how the health care delivery system is going to change post Covid-19 pandemic, and how India has remarkably managed to scale up vaccinations against the virus
By Rhythma Kaul, Hindustan Times, New Delhi
UPDATED ON SEP 15, 2021 04:34 AM IST

In an emailed interview to Rhythma Kaul, Gates Foundation co-chair Melinda French Gates explains how the health care delivery system is going to change post Covid-19 pandemic, and how India has remarkably managed to scale up vaccinations against the virus.

Edited excerpts:

1) How do you think the whole health care system will change post Covid-19?

The Covid-19 pandemic has affected everyone. But it did not affect everyone equally. Historically, marginalized countries and communities were hit the hardest, and they continue to bear a disproportionate burden of the suffering, both in their lives and in their economies. What’s also clear is that the countries that had invested in their health systems over decades were better prepared to manage the pandemic.

In the years to come, in addition to strengthening health systems, I’m optimistic the world will heed this lesson and make the long-term investments we need in research and development and manufacturing, especially when it comes to vaccines, and focus on interventions that best serve the most vulnerable. These investments are critical not just to address the next pandemic, but to get the world back on track to meet the Global Goals. And these investments must be made closer to the people who most stand to benefit, which helps us ensure that life-saving interventions and technologies are distributed equitably.

2) In the Indian context, what should be the key focus areas of the government to manage such a public health crisis?

The pandemic proves that preparing for crises starts years before they happen. India’s Covid-19 management and the country-wide immunization drive have demonstrated why long-term investments in health systems are crucial. In particular, India’s thriving R&D and vaccine manufacturing and delivery ecosystem have enabled the country to rapidly scale up Covid-19 immunization to deliver more than 750 million doses. That’s remarkable.

It is also important for governments to put systems in place that can more quickly help the most vulnerable people to minimise the impact of such a crisis. India is taking some encouraging steps to do just that, such as implementing its Digital Health Mission to boost the efficiency and transparency in the country’s health care services. And the Indian government’s direct benefit transfer program, which has provided financial support to 200 million women during the pandemic, has helped those who have been disproportionately impacted by Covid-19. Putting women at the centre of the economic recovery is something that all governments must continue to focus on and at the Gates Foundation, we remain committed to providing strong support to this. We’ve committed $2.1 billion globally over the next five years to promote women’s economic empowerment, to strengthen women and girls’ health and family planning, and to support women’s leadership.

It is clear that we have to make sure that the most vulnerable groups and communities are protected whenever such crises occur. Strengthening social safety nets, improving service delivery to vulnerable communities, including women, and ensuring access to affordable quality health care will continue to be critical areas to focus on.

3) How do you see this pandemic affecting global efforts to meet Sustainable Development Goals (SDGs)?

It will take years to understand the full extent of the pandemic’s impact on the SDGs. As this year’s Goalkeepers report demonstrates, we have already witnessed considerable setbacks but we’ve also been able to avoid some of the worst-case scenarios on several key indicators — thanks to people around the world stepping up. Consider the global goal for routine vaccine coverage. A year ago, we predicted a drop of 14 percentage points in global vaccine coverage, which would have amounted to 25 years of progress lost. New analysis from the Institute of Health Metrics and Evaluation shows the drop, while still unacceptable, was only half that.

We have a lot of ground to cover on some important indicators, especially on gender equality, and we need to ensure continued efforts and commitment even on the issues where we avoided catastrophe. This is not simply a fight for one country. Regaining the lost ground on the SDGs needs to be a priority global effort.

4) What’s your opinion on the inequity that we have seen in use of Covid-19 vaccines globally, wherein developed countries have vaccinated a major chunk of their population and are already looking at booster shots, and low-income countries are still waiting for doses?

Despite some historic successes and unprecedented collaborations, we still have a long way to go to ensure everyone has equal access to vaccines. Outbreaks and new variants around the world show the consequences of this vaccine inequity and the significant and tragic costs of inaction. We have a moral imperative to remove all barriers and use every lever available to rapidly improve access to Covid-19 vaccines for everybody, everywhere. We’ve been focused on this mission over the last year, and we will keep it up. Until more people worldwide get the vaccine, we won’t be able to put the pandemic behind us.

We’ve also seen that Covid-19 vaccine access is directly correlated with locations with vaccine R&D and manufacturing capability. Africa, for example, has 17 percent of the world’s population, but less than 1 percent of the world’s vaccine manufacturing capabilities. That’s why we support efforts to invest in and build a sustainable regional vaccine development and manufacturing ecosystem — to ensure vaccines can be available everywhere.

The path forward is challenging. But it’s not impossible. We all can and must do more to accelerate the distribution of Covid-19 vaccine doses. Any country or company sitting on the sidelines should step in to do its part.

5) What has been the silver lining looking at the past one-and-half year?

It’s hard to think about silver linings amid so much devastation but the Covid-19 pandemic has also shown our collective resolve, resilience, determination and capacity to fight these challenges with innovation and collaboration. In the toughest of circumstances, countless individuals, organisations and countries went above and beyond to innovate, adapt and build resilient systems and to look out for one another. In India, we witnessed the unprecedented efforts of government, private institutions and millions of ordinary individuals coming together to help those in need. The Gates Foundation was proud to partner with the government and Indian non-profits to expand testing, surveillance, vaccine discovery and evaluating new and repurposed drugs.

We also witnessed remarkable efforts from small collectives in India. Self-help groups played a crucial role in management of Covid-19 in their communities. For example, when Covid-19 arrived in Bihar — home to more than 100 million people — local self-help groups established trust with their neighbors by delivering meals and home-based health care to those who fell ill, then served as sources of information and support to encourage the community to get vaccinated.

In Uttar Pradesh, apart from playing a similar role of community support that peer groups did in Bihar, self-help groups have also been engaged by the government to facilitate the state’s ‘Take Home Ration’ program and to support the most vulnerable. There are so many examples like these, and they all demonstrate that some of the most effective interventions happen at a hyperlocal level, headed by leaders who have worked long and hard to earn the trust of their communities.

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